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Macular Degeneration:

What It Is and How to Treat It 
By Roger M. Kaldawy, M.D.
Milford Franklin Eye Center
Macular degeneration is one of the leading causes of vision loss, particularly among older adults, significantly impacting the quality of life for millions worldwide. This article examines macular degeneration, its symptoms and signs, diagnostic methods, current treatments, recent therapeutic advancements, and available care options.
What is Macular Degeneration?
Macular degeneration, often called age-related macular degeneration (AMD), is a progressive eye condition affecting the macula, the small central area of the retina responsible for sharp, detailed central vision. AMD is categorized into two primary types: dry (atrophic) and wet (neovascular).
• Dry AMD: The more common form, comprising 85–90% of cases. It occurs due to gradual thinning of the macula and the accumulation of drusen, yellow deposits under the retina. Vision loss progresses slowly in most cases.
• Wet AMD: Though less common, it is more severe, responsible for most advanced vision loss cases. It results from abnormal blood vessel growth under the retina, causing leakage, bleeding, and scarring, often leading to rapid vision loss without treatment.
Symptoms and Signs
Symptoms of macular degeneration vary by type and stage. Common signs include:
• Blurred central vision: Early signs may include difficulty reading or recognizing faces.
• Distorted vision (metamorphopsia): Straight lines may appear wavy or distorted.
• Difficulty adapting to low light: Challenges in transitioning from bright to dim environments.
• Central blind spots (scotomas): Dark or empty areas in the central field of vision.
• Reduced color perception: Colors may seem less vibrant over time.
Diagnostic Testing
Accurate diagnosis is vital for managing AMD effectively. Key diagnostic tools include:
• Comprehensive eye exam: Identifies early signs such as drusen or retinal changes.
• Amsler grid test: Detects distortions or blind spots in central vision.
• Optical coherence tomography (OCT): Offers detailed cross-sectional imaging of the retina, highlighting thinning or fluid accumulation.
• Fluorescein angiography: Highlights abnormal blood vessel growth and leakage in wet AMD.
• Fundus photography: Captures high-resolution retinal images to monitor changes over time.
Current Treatment Options
Treatment depends on the type and severity of AMD:
• Dry AMD:
While no definitive cure exists, lifestyle modifications and supportive care can slow progression:
– Nutritional supplements: The AREDS2 formula (antioxidants, zinc, and copper) reduces the risk of advanced AMD.
– Lifestyle changes: A healthy diet rich in leafy greens, omega-3 fatty acids, avoiding smoking, and UV protection are essential.
• Wet AMD:
Treatment focuses on halting abnormal blood vessel growth:
– Anti-VEGF therapy: Medications like ranibizumab (Lucentis), aflibercept (Eylea), and brolucizumab (Beovu) inhibit vascular endothelial growth factor (VEGF), reducing abnormal vessel formation.
– Photodynamic therapy (PDT): Combines a light-sensitive drug with laser activation to target abnormal vessels.
– Laser therapy: Less commonly used, this destroys abnormal blood vessels with laser energy.
New Therapeutic Advancements
Advancements in AMD research are offering improved outcomes:
• Gene therapy: Experimental approaches aim to deliver protective genes to the retina, reducing the need for frequent anti-VEGF injections.
• Long-lasting drug delivery systems: Innovations like the Port Delivery System (PDS) with ranibizumab provide sustained medication release, minimizing injection frequency.
• Stem cell therapy: Research explores using stem cell-derived retinal pigment epithelial (RPE) cells to replace damaged macular cells.
• New pharmacological agents: Drugs like complement inhibitors (e.g., pegcetacoplan) target previously untreatable stages of dry AMD and geographic atrophy.
Living with Macular Degeneration
Managing AMD extends beyond medical treatment and includes:
• Low vision aids: Magnifiers, special glasses, and electronic devices maintain independence.
• Support networks: Connecting with groups and counseling provides emotional and practical support.
• Routine monitoring: Regular follow-ups ensure timely interventions and management adjustments.
Macular degeneration presents significant challenges, but early detection and proactive management can preserve vision and improve quality of life. If you experience symptoms or have risk factors, schedule a comprehensive eye exam with an eye care professional.
At Milford Franklin Eye Center, we use state-of-the-art technology to address a variety of eye conditions, including macular degeneration. Our dedicated retina specialist focuses on treating retinal eye diseases and AMD, utilizing the most recent treatment modalities discussed in this article. With advanced equipment rivaling the best teaching eye hospitals, we proudly offer world-class eye care close to home.
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